Certain psychiatric conditions may prompt some women to choose to have their ovaries removed even when there is no medical justification for it, a new study suggests.
“Some women suffer from psychiatric conditions that may change their perception of pain, bleeding and somatic symptoms, or may prompt the desire to address such symptoms with medical or surgical treatments,” said study coauthor Dr. Walter Rocca, a professor of epidemiology and neurology in the department of health sciences research at the Mayo Clinic in Rochester, Minn.
“These women may undergo a complex itinerary of interactions with primary care providers and may try several medical treatments,” Rocca said in email. “When the treatments fail to address the pain or discomfort, some women get referred for gynecological care or directly for gynecological surgery.”
To take a closer look at whether mental health conditions might have an impact on the likelihood a woman would choose to have her ovaries removed, a surgery known as oophorectomy, Rocca and his colleagues compared 1,653 premenopausal women who had their ovaries removed despite having no signs of cancer. The women had their surgeries during the 20-year period from 1988 to 2007. They were matched in age to a control group of 1,653 women who did not have the surgery.
After analyzing their data, the researchers found that pre-existing mood disorders, anxiety disorders and somatoform disorders were associated with an increased risk of women choosing to have both ovaries removed. And that risk rose when women suffered from multiple disorders, the researchers reported.
Women with one disorder were 1.55 times more likely to have an oophorectomy, while those with three or more disorders were 2.19 times more likely to get the surgery, the researchers reported in the journal Menopause.
“Unfortunately,” Rocca said, “the surgery may not remove the pain or discomfort and will cause important long-term harmful effects. There is a need to develop more conservative strategies to address gynecological symptoms in the absence of clear pathology.”
Ovary removal will send a woman into early menopause. Along with bringing on symptoms such as hot flashes, sleeping problems and reduced vaginal lubrication, it can increase her risk of heart disease and osteoporosis.
The best way to avoid unnecessary oophorectomies is through “patient and physician education,” said Dr. Konstantin Zakashansky, director of minimally invasive surgery at the Mount Sinai Health System and an associate professor of gynecologic oncology at the Icahn School of Medicine at Mount Sinai in New York.
While the new study is “important in identifying additional risk factors for oophorectomy,” newer data might have yielded somewhat different findings because surgical practice has changed over the last several decades, Zakashansky said in an email. “Our attitudes (patients and physicians) towards performing prophylactic oophorectomy in premenopausal and postmenopausal patients have changed (dramatically) over the last 10 years. We have become more conservative in making the decision to perform oophorectomy based on recent data pointing to significant long-term adverse health consequences associated with removing ovaries.”
The change has been made possible because of technological advances, Zakashansky said. “Imaging techniques (3D ultrasonography and MRI), biomarker and genetic testing have improved over the last 20 years enhancing our ability to differentiate between malignant and non-malignant ovarian conditions,” he explained.
SOURCE: Menopause, online August 30, 2019.